Massachusetts All-Payer Claims Database Technical Assistance
Explore updates on enrollment trends, medical expenditure, risk adjustment, and upcoming file submission deadlines in the Massachusetts All-Payer Claims Database Technical Assistance Group meeting held on February 9, 2016.
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Presentation Transcript
Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) February 9, 2016
Agenda Housekeeping Annual Premium, Enrollment Trends and Medical Expenditure Trends Updates Wrap Up
Housekeeping APCD V5 Submission Guides Risk Adjustment Upcoming File Submission Deadlines Proposed Changes to TME/APM Reporting
Intake Version 5.0 MA APCD Intake Process Timeline Data Partners Propose Version 5 Updates November 2015 Proposals Shared/Discussed with Carriers December 2015 Draft Submission Guides published January 2016 Guides Reviewed at Technical Advisory Group January 2016 Carrier Comment Period January 2016 Administrative Bulletin and Guides Adopted February 2016 Development/Testing March/June 2016 Carrier Testing July 2016 MA APCD Intake Version 5 Production August 2016
PV011 - Suffix D/N DC DO DPM HC HO KT LAC MD MT ND OF OT PA PT R SLP ST Dietitian/Nutritionist Doctor of Chiropractic Doctor of Osteopathy Doctor of Podiatric Medicine Homecare Hospital Based PM&R Kinesiotherapist Licensed Acupuncturist Medical Doctor Massage Therapist Naturopathic Physician Physician Office Based PM&R Occupational Therapist Physicians Assistant Physical Therapist Rolfer Speech Language Pathologist Speech Therapist
Risk Adjustment Deadline extended to 2/26/2016 for submitting Supplemental Diagnosis file for December 2015 Inform your liaison if you plan on submitting this file type for Risk Adjustment Connector/Milliman joining upcoming bi-weekly calls to discuss the Q4 2015 Data Quality reports
Upcoming File Submission Deadlines Files (through March 2016) for the next CHIA data release must be in and passed intake edits by 4/30/2016. This also coincides with the Risk Adjustment final settlement. V5 submission guides go into effect in August for July 2016 data and any resubmissions back to October 2013.
Proposed Changes to TME/APM Reporting Please send any comments or questions by Friday, February 12th to: Caitlin Sullivan, Policy Implementation Manager caitlin.sullivan2@state.ma.us All TME/APM/RP and TAG materials can be found here: http://www.chiamass.gov/information-for-data-submitters-payer- data-reporting/
CHIA Reporting Updates: Annual Premiums Data Request, Enrollment Trends, and Medical Expenditure Trends Kevin Meives | Senior Health System Policy Analyst Ashley Storms | Senior Health System Policy Analyst Nathan Bosdet | Senior Health System Policy Analyst February 9th, 2016
Annual Premiums Data Request
2016 Annual Premiums Data Request Update Draft Data Submission Manual o Comments due to Kevin Meives at kevin.meives@state.ma.us by February 12th Limited Network Definition Flat File Submission Option Timeline 11
Limited Networks Proposed Definition Cost/Premium Threshold MA DOI definition uses 14% cost threshold o Proposing using 10% threshold Fully-Insured Plans Apply threshold based on premium relativities in manual rating algorithm o A network that is considered limited in Merged Market would also be so in large group Self-Insured Plans Apply fully-insured criteria to self-insured networks 12
Flat File Submission Option Submission Format: Submission Guidelines: 13
Timeline Feb. 12th 2016 Feb. 17th 2016 March 2016 April 2016 May 2016 Comments on Draft Data Submission Manual Due Finalized Data Submission Manual posted Payer TAG #1 (March 8th) Payer TAG #2 (April 12th) Submissions Due (May 10th) 14
Total Massachusetts Enrollment March 2014 September 2015 16
Private Commercial Enrollment September 2014 September 2015 17
Timeline Jan. 2016 Feb. 2016 Mar. 2016 Apr. 2016 May 2016 June 2016 July 2016 Reporting Work with remaining payers to fix MA APCD ME files; Validate new MA APCD fields for ongoing enrollment reporting March 2016 MA APCD file submissions Supplemental reporting due (required payers) Payer data verification Reporting 18
Medical Expenditure Trends
Financial Control Totals Follow-up CHIA has sent (via your payer liaison) an Excel workbook in which we have asked you to provide certain key per member per month financial values generated from your internal reporting systems. We have asked that these be returned by Thursday, February 25th. 20
Contact Information For questions about Annual Premiums: Contactyour CHIA liaison and Kevin Meives at kevin.meives@state.ma.us For questions about Enrollment Trends: Contactyour CHIA liaison and Ashley Storms at ashley.storms@state.ma.us For questions about Medical Expenditure Trends: Contactyour CHIA liaison and Nathan Bosdet at nathan.bosdet@state.ma.us 21
Next Meetings March 8, 2016 @ 2:00 pm April 12, 2016 @ 2:00 pm
